The Metro DC Health Information Exchange (MeDHIX) project will establish a sustainable capability for longitudinal, cross-enterprise electronic health records for the low income, uninsured population in the metropolitan District of Columbia region to improve patient safety and quality and efficiency of care for the region's most vulnerable population. MeDHIX will meet this objective through the implementation of a Health Information Exchange linking the electronic health record systems of Safety Net clinics in the region with each other and with mainstream healthcare providers, forming a regional Community of Interest focused on the specific and unique needs of the uninsured population and safety net environment. Initial focus of MeDHIX will be in providing Emergency Department clinicians with health information, including medications data, from the safety net clinics, and providing safety net clinicians with similar health information from the Emergency Departments, to increase the knowledge base on which the clinician makes assessments and medications decisions, ultimately improving patient safety and quality of care. Additionally, MeDHIX will focus on reducing duplicative labs and procedures and reducing unnecessary visits to the [unreadable] Emergency Departments. MeDHIX will be implemented in phases. The first phase will leverage existing technology to rapidly deploy a significant subset of provider participants to address the issues of cross-jurisdictional, cross enterprise health information exchange. The second phase will be paced with the promulgation of standards, protocols and operating guidelines necessary for Community of Interest HIE's, such as MeDHIX, to interoperate within the evolving Regional Health Information Exchange and National Health Information Network environment. The third phase will further refine the HIE technology as standards evolve, and will extend the number of regional participants. From the first phase onward enhanced data will be available for public health planning, epidemiological surveillance and targeting of services to the low income uninsured. [unreadable] [unreadable] [unreadable]